Outcomes in asymptomatic, severe aortic stenosis
Patients with asymptomatic, severe aortic stenosis are presumed to have a benign prognosis. In this retrospective cohort study, we examined the natural history of contemporary patients advised against aortic valve replacement due to a perceived lack of symptoms. We reviewed the medical records of ev...
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| Published in | PloS one Vol. 16; no. 4; p. e0249610 |
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| Main Authors | , , , , , , , , |
| Format | Journal Article |
| Language | English |
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United States
Public Library of Science
07.04.2021
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| Abstract | Patients with asymptomatic, severe aortic stenosis are presumed to have a benign prognosis. In this retrospective cohort study, we examined the natural history of contemporary patients advised against aortic valve replacement due to a perceived lack of symptoms.
We reviewed the medical records of every patient given the ICD-10-code for aortic stenosis (I35.0) at Oslo University Hospital, Rikshospitalet, between Dec 1st, 2002 and Dec 31st, 2016. Patients who were evaluated by the heart team due to severe aortic stenosis were categorized by treatment strategy. We recorded baseline data, adverse events and survival for the patients characterized as asymptomatic and for 100 age and gender matched patients scheduled for aortic valve replacement.
Of 2341 patients who were evaluated for aortic valve replacement due to severe aortic stenosis, 114 patients received conservative treatment due to a lack of symptoms. Asymptomatic patients had higher mortality than patients who had aortic valve replacement, log-rank p<0.001 (mean follow-up time: 4.0 (SD: 2.5) years). Survival at 1, 2 and 3 years for the asymptomatic patients was 88%, 75% and 63%, compared with 92%, 83% and 78% in the matched patients scheduled for aortic valve replacement. 28 (25%) of the asymptomatic patients had aortic valve replacement during follow-up. Age, previous history of coronary artery disease and N-terminal pro B-type natriuretic peptide (NT-proBNP) were predictors of mortality and coronary artery disease and NT-proBNP were predictors of 3-year morbidity in asymptomatic patients.
In this retrospective study, asymptomatic patients with severe aortic stenosis who were advised against surgery had significantly higher mortality than patients who had aortic valve replacement. |
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| AbstractList | We reviewed the medical records of every patient given the ICD-10-code for aortic stenosis (I35.0) at Oslo University Hospital, Rikshospitalet, between Dec 1.sup.st, 2002 and Dec 31.sup.st, 2016. Patients who were evaluated by the heart team due to severe aortic stenosis were categorized by treatment strategy. We recorded baseline data, adverse events and survival for the patients characterized as asymptomatic and for 100 age and gender matched patients scheduled for aortic valve replacement. Of 2341 patients who were evaluated for aortic valve replacement due to severe aortic stenosis, 114 patients received conservative treatment due to a lack of symptoms. Asymptomatic patients had higher mortality than patients who had aortic valve replacement, log-rank p<0.001 (mean follow-up time: 4.0 (SD: 2.5) years). Survival at 1, 2 and 3 years for the asymptomatic patients was 88%, 75% and 63%, compared with 92%, 83% and 78% in the matched patients scheduled for aortic valve replacement. 28 (25%) of the asymptomatic patients had aortic valve replacement during follow-up. Age, previous history of coronary artery disease and N-terminal pro B-type natriuretic peptide (NT-proBNP) were predictors of mortality and coronary artery disease and NT-proBNP were predictors of 3-year morbidity in asymptomatic patients. In this retrospective study, asymptomatic patients with severe aortic stenosis who were advised against surgery had significantly higher mortality than patients who had aortic valve replacement. Background and aim of the studyPatients with asymptomatic, severe aortic stenosis are presumed to have a benign prognosis. In this retrospective cohort study, we examined the natural history of contemporary patients advised against aortic valve replacement due to a perceived lack of symptoms.Materials and methodsWe reviewed the medical records of every patient given the ICD-10-code for aortic stenosis (I35.0) at Oslo University Hospital, Rikshospitalet, between Dec 1st, 2002 and Dec 31st, 2016. Patients who were evaluated by the heart team due to severe aortic stenosis were categorized by treatment strategy. We recorded baseline data, adverse events and survival for the patients characterized as asymptomatic and for 100 age and gender matched patients scheduled for aortic valve replacement.ResultsOf 2341 patients who were evaluated for aortic valve replacement due to severe aortic stenosis, 114 patients received conservative treatment due to a lack of symptoms. Asymptomatic patients had higher mortality than patients who had aortic valve replacement, log-rank p<0.001 (mean follow-up time: 4.0 (SD: 2.5) years). Survival at 1, 2 and 3 years for the asymptomatic patients was 88%, 75% and 63%, compared with 92%, 83% and 78% in the matched patients scheduled for aortic valve replacement. 28 (25%) of the asymptomatic patients had aortic valve replacement during follow-up. Age, previous history of coronary artery disease and N-terminal pro B-type natriuretic peptide (NT-proBNP) were predictors of mortality and coronary artery disease and NT-proBNP were predictors of 3-year morbidity in asymptomatic patients.ConclusionsIn this retrospective study, asymptomatic patients with severe aortic stenosis who were advised against surgery had significantly higher mortality than patients who had aortic valve replacement. Background and aim of the study Patients with asymptomatic, severe aortic stenosis are presumed to have a benign prognosis. In this retrospective cohort study, we examined the natural history of contemporary patients advised against aortic valve replacement due to a perceived lack of symptoms. Materials and methods We reviewed the medical records of every patient given the ICD-10-code for aortic stenosis (I35.0) at Oslo University Hospital, Rikshospitalet, between Dec 1st, 2002 and Dec 31st, 2016. Patients who were evaluated by the heart team due to severe aortic stenosis were categorized by treatment strategy. We recorded baseline data, adverse events and survival for the patients characterized as asymptomatic and for 100 age and gender matched patients scheduled for aortic valve replacement. Results Of 2341 patients who were evaluated for aortic valve replacement due to severe aortic stenosis, 114 patients received conservative treatment due to a lack of symptoms. Asymptomatic patients had higher mortality than patients who had aortic valve replacement, log-rank p<0.001 (mean follow-up time: 4.0 (SD: 2.5) years). Survival at 1, 2 and 3 years for the asymptomatic patients was 88%, 75% and 63%, compared with 92%, 83% and 78% in the matched patients scheduled for aortic valve replacement. 28 (25%) of the asymptomatic patients had aortic valve replacement during follow-up. Age, previous history of coronary artery disease and N-terminal pro B-type natriuretic peptide (NT-proBNP) were predictors of mortality and coronary artery disease and NT-proBNP were predictors of 3-year morbidity in asymptomatic patients. Conclusions In this retrospective study, asymptomatic patients with severe aortic stenosis who were advised against surgery had significantly higher mortality than patients who had aortic valve replacement. Background and aim of the study Patients with asymptomatic, severe aortic stenosis are presumed to have a benign prognosis. In this retrospective cohort study, we examined the natural history of contemporary patients advised against aortic valve replacement due to a perceived lack of symptoms. Materials and methods We reviewed the medical records of every patient given the ICD-10-code for aortic stenosis (I35.0) at Oslo University Hospital, Rikshospitalet, between Dec 1.sup.st, 2002 and Dec 31.sup.st, 2016. Patients who were evaluated by the heart team due to severe aortic stenosis were categorized by treatment strategy. We recorded baseline data, adverse events and survival for the patients characterized as asymptomatic and for 100 age and gender matched patients scheduled for aortic valve replacement. Results Of 2341 patients who were evaluated for aortic valve replacement due to severe aortic stenosis, 114 patients received conservative treatment due to a lack of symptoms. Asymptomatic patients had higher mortality than patients who had aortic valve replacement, log-rank p<0.001 (mean follow-up time: 4.0 (SD: 2.5) years). Survival at 1, 2 and 3 years for the asymptomatic patients was 88%, 75% and 63%, compared with 92%, 83% and 78% in the matched patients scheduled for aortic valve replacement. 28 (25%) of the asymptomatic patients had aortic valve replacement during follow-up. Age, previous history of coronary artery disease and N-terminal pro B-type natriuretic peptide (NT-proBNP) were predictors of mortality and coronary artery disease and NT-proBNP were predictors of 3-year morbidity in asymptomatic patients. Conclusions In this retrospective study, asymptomatic patients with severe aortic stenosis who were advised against surgery had significantly higher mortality than patients who had aortic valve replacement. Patients with asymptomatic, severe aortic stenosis are presumed to have a benign prognosis. In this retrospective cohort study, we examined the natural history of contemporary patients advised against aortic valve replacement due to a perceived lack of symptoms. We reviewed the medical records of every patient given the ICD-10-code for aortic stenosis (I35.0) at Oslo University Hospital, Rikshospitalet, between Dec 1st, 2002 and Dec 31st, 2016. Patients who were evaluated by the heart team due to severe aortic stenosis were categorized by treatment strategy. We recorded baseline data, adverse events and survival for the patients characterized as asymptomatic and for 100 age and gender matched patients scheduled for aortic valve replacement. Of 2341 patients who were evaluated for aortic valve replacement due to severe aortic stenosis, 114 patients received conservative treatment due to a lack of symptoms. Asymptomatic patients had higher mortality than patients who had aortic valve replacement, log-rank p<0.001 (mean follow-up time: 4.0 (SD: 2.5) years). Survival at 1, 2 and 3 years for the asymptomatic patients was 88%, 75% and 63%, compared with 92%, 83% and 78% in the matched patients scheduled for aortic valve replacement. 28 (25%) of the asymptomatic patients had aortic valve replacement during follow-up. Age, previous history of coronary artery disease and N-terminal pro B-type natriuretic peptide (NT-proBNP) were predictors of mortality and coronary artery disease and NT-proBNP were predictors of 3-year morbidity in asymptomatic patients. In this retrospective study, asymptomatic patients with severe aortic stenosis who were advised against surgery had significantly higher mortality than patients who had aortic valve replacement. Patients with asymptomatic, severe aortic stenosis are presumed to have a benign prognosis. In this retrospective cohort study, we examined the natural history of contemporary patients advised against aortic valve replacement due to a perceived lack of symptoms.BACKGROUND AND AIM OF THE STUDYPatients with asymptomatic, severe aortic stenosis are presumed to have a benign prognosis. In this retrospective cohort study, we examined the natural history of contemporary patients advised against aortic valve replacement due to a perceived lack of symptoms.We reviewed the medical records of every patient given the ICD-10-code for aortic stenosis (I35.0) at Oslo University Hospital, Rikshospitalet, between Dec 1st, 2002 and Dec 31st, 2016. Patients who were evaluated by the heart team due to severe aortic stenosis were categorized by treatment strategy. We recorded baseline data, adverse events and survival for the patients characterized as asymptomatic and for 100 age and gender matched patients scheduled for aortic valve replacement.MATERIALS AND METHODSWe reviewed the medical records of every patient given the ICD-10-code for aortic stenosis (I35.0) at Oslo University Hospital, Rikshospitalet, between Dec 1st, 2002 and Dec 31st, 2016. Patients who were evaluated by the heart team due to severe aortic stenosis were categorized by treatment strategy. We recorded baseline data, adverse events and survival for the patients characterized as asymptomatic and for 100 age and gender matched patients scheduled for aortic valve replacement.Of 2341 patients who were evaluated for aortic valve replacement due to severe aortic stenosis, 114 patients received conservative treatment due to a lack of symptoms. Asymptomatic patients had higher mortality than patients who had aortic valve replacement, log-rank p<0.001 (mean follow-up time: 4.0 (SD: 2.5) years). Survival at 1, 2 and 3 years for the asymptomatic patients was 88%, 75% and 63%, compared with 92%, 83% and 78% in the matched patients scheduled for aortic valve replacement. 28 (25%) of the asymptomatic patients had aortic valve replacement during follow-up. Age, previous history of coronary artery disease and N-terminal pro B-type natriuretic peptide (NT-proBNP) were predictors of mortality and coronary artery disease and NT-proBNP were predictors of 3-year morbidity in asymptomatic patients.RESULTSOf 2341 patients who were evaluated for aortic valve replacement due to severe aortic stenosis, 114 patients received conservative treatment due to a lack of symptoms. Asymptomatic patients had higher mortality than patients who had aortic valve replacement, log-rank p<0.001 (mean follow-up time: 4.0 (SD: 2.5) years). Survival at 1, 2 and 3 years for the asymptomatic patients was 88%, 75% and 63%, compared with 92%, 83% and 78% in the matched patients scheduled for aortic valve replacement. 28 (25%) of the asymptomatic patients had aortic valve replacement during follow-up. Age, previous history of coronary artery disease and N-terminal pro B-type natriuretic peptide (NT-proBNP) were predictors of mortality and coronary artery disease and NT-proBNP were predictors of 3-year morbidity in asymptomatic patients.In this retrospective study, asymptomatic patients with severe aortic stenosis who were advised against surgery had significantly higher mortality than patients who had aortic valve replacement.CONCLUSIONSIn this retrospective study, asymptomatic patients with severe aortic stenosis who were advised against surgery had significantly higher mortality than patients who had aortic valve replacement. |
| Audience | Academic |
| Author | Kvaslerud, Anette Borger Skulstad, Helge Auensen, Andreas Fiane, Arnt Santic, Kenan Broch, Kaspar Aaberge, Lars Gullestad, Lars Hussain, Amjad Iqbal |
| AuthorAffiliation | 2 Department of Cardiology, Oslo University Hospital, Rikshospitalet, Norway Ospedale del Cuore G Pasquinucci Fondazione Toscana Gabriele Monasterio di Massa, ITALY 4 Department of Cardiothoracic Surgery, Oslo University Hospital, Rikshospitalet, Norway 3 KG Jebsen Cardiac Research Center and Center for Heart Failure Research, Oslo University Hospital, Ullevål, Norway 1 Faculty of Medicine, University of Oslo, Oslo, Norway |
| AuthorAffiliation_xml | – name: 2 Department of Cardiology, Oslo University Hospital, Rikshospitalet, Norway – name: 4 Department of Cardiothoracic Surgery, Oslo University Hospital, Rikshospitalet, Norway – name: Ospedale del Cuore G Pasquinucci Fondazione Toscana Gabriele Monasterio di Massa, ITALY – name: 1 Faculty of Medicine, University of Oslo, Oslo, Norway – name: 3 KG Jebsen Cardiac Research Center and Center for Heart Failure Research, Oslo University Hospital, Ullevål, Norway |
| Author_xml | – sequence: 1 givenname: Anette Borger orcidid: 0000-0001-9923-2685 surname: Kvaslerud fullname: Kvaslerud, Anette Borger – sequence: 2 givenname: Kenan surname: Santic fullname: Santic, Kenan – sequence: 3 givenname: Amjad Iqbal surname: Hussain fullname: Hussain, Amjad Iqbal – sequence: 4 givenname: Andreas surname: Auensen fullname: Auensen, Andreas – sequence: 5 givenname: Arnt surname: Fiane fullname: Fiane, Arnt – sequence: 6 givenname: Helge surname: Skulstad fullname: Skulstad, Helge – sequence: 7 givenname: Lars surname: Aaberge fullname: Aaberge, Lars – sequence: 8 givenname: Lars surname: Gullestad fullname: Gullestad, Lars – sequence: 9 givenname: Kaspar surname: Broch fullname: Broch, Kaspar |
| BackLink | https://www.ncbi.nlm.nih.gov/pubmed/33826652$$D View this record in MEDLINE/PubMed |
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| CitedBy_id | crossref_primary_10_1080_14779072_2022_2137491 crossref_primary_10_1161_CIRCULATIONAHA_121_057639 crossref_primary_10_1093_ehjci_jead132 crossref_primary_10_3390_jcm12247694 crossref_primary_10_12677_ACM_2023_133512 crossref_primary_10_1016_j_ijcha_2022_101125 crossref_primary_10_1016_j_carrev_2023_08_016 crossref_primary_10_1016_j_cjca_2023_11_029 crossref_primary_10_15836_ccar2021_291 crossref_primary_10_1016_j_jscai_2022_100383 crossref_primary_10_1016_j_amjcard_2024_02_034 crossref_primary_10_1136_openhrt_2022_001982 crossref_primary_10_3390_diagnostics13111828 crossref_primary_10_4103_jiae_jiae_18_23 crossref_primary_10_1016_j_jacadv_2023_100356 crossref_primary_10_1136_heartjnl_2022_321411 crossref_primary_10_3390_pathophysiology30020015 |
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| Copyright | COPYRIGHT 2021 Public Library of Science 2021 Kvaslerud et al. This is an open access article distributed under the terms of the Creative Commons Attribution License: http://creativecommons.org/licenses/by/4.0/ (the “License”), which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License. info:eu-repo/semantics/openAccess 2021 Kvaslerud et al 2021 Kvaslerud et al |
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| DOI | 10.1371/journal.pone.0249610 |
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| References | RA Nishimura (pone.0249610.ref002) 2014; 148 P Lancellotti (pone.0249610.ref016) 2018; 3 RG Pai (pone.0249610.ref017) 2006; 82 D-H Kang (pone.0249610.ref011) 2019; 382 PA Pellikka (pone.0249610.ref004) 1990; 15 Y Bohbot (pone.0249610.ref010) 2018; 72 T Taniguchi (pone.0249610.ref007) 2015; 66 R Rosenhek (pone.0249610.ref003) 2000; 343 I Bouhout (pone.0249610.ref014) 2019 Y Henchoz (pone.0249610.ref021) 2017; 7 P Genereux (pone.0249610.ref012) 2016; 67 WY Lim (pone.0249610.ref013) 2017; 103 J Campo (pone.0249610.ref006) 2019 SA George (pone.0249610.ref008) 2019; 31 PA Pellikka (pone.0249610.ref020) 2005; 111 R Morgan (pone.0249610.ref022) 1997; 47 K Nakatsuma (pone.0249610.ref023) 2018 J Ross (pone.0249610.ref005) 1968; 38 HJ Kim (pone.0249610.ref009) 2019; 123 A Vahanian (pone.0249610.ref019) 2012; 33 H Baumgartner (pone.0249610.ref001) 2017; 38 M Cattaneo (pone.0249610.ref018) 2017; 17 pone.0249610.ref015 |
| References_xml | – year: 2019 ident: pone.0249610.ref006 article-title: Prognosis of Severe Asymptomatic Aortic Stenosis With and Without Surgery publication-title: The Annals of thoracic surgery contributor: fullname: J Campo – volume: 123 start-page: 1321 issue: 8 year: 2019 ident: pone.0249610.ref009 article-title: Impact of Valve Replacement on Long-Term Survival in Asymptomatic Patients With Severe Aortic Stenosis. publication-title: The American journal of cardiology doi: 10.1016/j.amjcard.2019.01.035 contributor: fullname: HJ Kim – volume: 72 start-page: 2938 issue: 23 Pt A year: 2018 ident: pone.0249610.ref010 article-title: Asymptomatic Severe Aortic Stenosis With Preserved Ejection Fraction: Early Surgery Versus Conservative Management publication-title: Journal of the American College of Cardiology doi: 10.1016/j.jacc.2018.09.049 contributor: fullname: Y Bohbot – ident: pone.0249610.ref015 – volume: 82 start-page: 2116 issue: 6 year: 2006 ident: pone.0249610.ref017 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| Snippet | Patients with asymptomatic, severe aortic stenosis are presumed to have a benign prognosis. In this retrospective cohort study, we examined the natural history... Background and aim of the study Patients with asymptomatic, severe aortic stenosis are presumed to have a benign prognosis. In this retrospective cohort study,... We reviewed the medical records of every patient given the ICD-10-code for aortic stenosis (I35.0) at Oslo University Hospital, Rikshospitalet, between Dec... Background and aim of the study Patients with asymptomatic, severe aortic stenosis are presumed to have a benign prognosis. In this retrospective cohort study,... Background and aim of the studyPatients with asymptomatic, severe aortic stenosis are presumed to have a benign prognosis. In this retrospective cohort study,... |
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| Title | Outcomes in asymptomatic, severe aortic stenosis |
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